FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 05/17/2006 |
3. Issuer Name and Ticker or Trading Symbol
UNIVERSAL HEALTH SERVICES INC [ UHS ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Class B Common Stock | 400,000 | I | MMA Family, LLC(1) |
Class B Common Stock | 1,953 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Class A Common Stock | (2) | (3) | Class B Common Stock | 444,447 | (4) | I | A. Miller Family, LLC |
Class A Common Stock | (2) | (3) | Class B Common Stock | 25,250 | (4) | I | The Abby Danielle Miller 2002 Trust |
Class A Common Stock | (2) | (3) | Class B Common Stock | 25,250 | (4) | I | The Marni Spencer 2002 Trust |
Class A Common Stock | (2) | (3) | Class B Common Stock | 25,250 | (4) | I | The Marc Daniel Miller 2002 Trust |
Option to purchase Class B Common Stock | (5) | 02/19/2007 | Class B Common Stock | 1,250 | 40.95 | D | |
Option to purchase Class B Common Stock | (6) | 03/19/2008 | Class B Common Stock | 1,000 | 38.5 | D | |
Option to purchase Class B Common Stock | (7) | 03/14/2010 | Class B Common Stock | 20,000 | 48.85 | D |
Explanation of Responses: |
1. Marc D. Miller disclaims beneficial ownership of the securities attributable to Jill Miller and The Marni Spencer 2005 GRAT and The Abby Miller King 2005 GRAT as members of the MMA Family, LLC, and this report shall not be deemed an admission that he is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. |
2. Immediately. |
3. Not Applicable. |
4. These shares are convertible to Class B Common Stock on a share for share basis. |
5. The option became exercisable on February 19, 2003. |
6. The option became exercisable as to 500 shares on March 19, 2004, and the remaining 500 shares shall vest on March 19, 2007. |
7. The option became exercisable as to 5,000 shares on March 15, 2006, and the remaining 15,000 shares shall vest on March 15, 2007, March 15, 2008 and March 15, 2009. |
/s/ Marc D. Miller | 05/19/2006 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |